The Jarisch-Herxheimer reaction: Misinterpretations, exaggerated claims and abuses
Today we will be talking about an idea and invention important to all mankind – antibiotics. On Earth and in space, we humans are prone to getting sick, in multiple ways. This is simply the way our immune systems operate, so as always – knowledge is power.
The Spanish physician Ruya Díaz de Isla gave humanity, in which he excellently described the diagnosis and treatment of syphilis, a sexually transmitted disease caused by the bacterium Treponema pallidum.
He came up with the epidemiological idea that syphilis arrived from America after Columbus’s discovery, which will remain one of the possible scenarios of the past of this disease even today.
Ruya was not the first to describe the treatment of syphilis with mercury and mercury salts, but he was the first to describe the side effect of the treatment, a transient fever after which, supposedly, they would recover.
No one paid any attention to it for three and a half centuries.
In 1895, Austro-Hungarian dermatologist Adolf Jarisch described a similar reaction during the treatment of syphilis, which was confirmed by German dermatologist Karl Herxheimer in 1902.
The world came to know the concept of the Jarisch-Herxheimer reaction.
After mercury and mercury salts, new antimicrobial compounds – antibiotics – were discovered.
The arsenic compound Salvarsan (arsphenamine) was the first specific antibiotic against the causative agent of syphilis, but also the causative agent of sleeping sickness and the causative agent of relapsing fever, a bacterium from the genus Borrelia.
Later, other antibiotics came and the more effective the treatment, the more often the Jarisch-Herxheimer reaction was encountered.
Research into the cause of this reaction will encourage the cooperation of two related disciplines – microbiology and immunology.
What are the symptoms of a Jarisch-Herxheimer reaction?
Within a few hours after the first dose of antibiotics, some of the following symptoms may occur:
- fever and chills
- muscle pain and headache
- skin reactions
- rapid heartbeat and drop in blood pressure
Some more severe, even life-threatening forms are rarely recorded.
Does the Jarisch-Herxheimer reaction always occur when treating bacterial infections?
No, it will not happen during every treatment. It most often occurs during the treatment of infections with a group of bacteria called spirochetes.
These are the causes:
- Syphilis,
- Treponema pallidum,
- Lyme disease and relapsing fever caused by bacteria of the genus Borrelia,
- Leptospirosis caused by bacteria of the genus Leptospira.
Even with these diseases, the reaction does not have to occur. It is sometimes described in other causative agents of diseases, such as Q fever, sleeping sickness, bordetellosis and others.
It is very rare in some other bacteria such as streptococcus.
Why does the Jarisch-Herxheimer reaction occur?
Sudden killing of microorganisms causes their disintegration. The immune system recognizes some decomposed substances, such as lipoporotein, the causative agent of syphilis, and triggers an alarm.
This alarm triggers inflammatory substances created by the immune system, hence fever, weakness and muscle aches, similar to flu symptoms.
Skin symptoms are a consequence of the same process. It is a fortunate circumstance that the immune system has fine control mechanisms and in the case of most infections, despite the “death” of the microorganisms, reactions fortunately do not occur.
The Jarisch-Herxheimer reaction usually goes away on its own, although sometimes the doctor will intervene to reduce the symptoms.
Possible confusion and misuse of the term
After the Second World War, with the advent of the antibiotic penicillin, it was realized that some reactions similar to the Jarisch-Herxheimer reaction could be caused by other causes, for example allergic reactions to the drug itself.
Sometimes the possibility of a nocebo effect should be kept in mind, both due to the treatment itself and the fear of the disease itself, especially with symptoms that are common with nocebo effects, such as headache, muscle pain and a feeling of a pounding heart, with the absence of other symptoms.
The Jarisch-Herxheimer reaction would have remained exclusively in the domain of medicine, but very quickly it became a popular term with the advent of the Internet and social networks.
It is closely related to the concept of the die-off effect, which means that the treatment of all infections will be followed by a reaction similar to Jarisch-Herxheimer’s.
Sometimes it can be connected with collective psychological tendencies to desire suffering and the idea that any healing (not only infectious diseases) must go through a crisis. You look for analysis in other professions, like psychology.
The Jarisch-Herxheimer reaction has become so popular that it is simply called “Herx” and its existence is attributed to almost any reaction or condition. For example, the occurrence of only a headache is not really a “Herx”.
Unfortunately, some treatment procedures are really not pleasant, but in the case of quite a few diseases, we can simply be better off. And that’s all. To be honest, this is what we fought for over the centuries.
It has already been said that some Jarisch-Herxheimer reactions are just confusion in diagnosing side effects of antibiotics.
This also applies to various preparations, so nausea, diarrhea, allergic skin reactions and other symptoms caused by those preparations are attributed exclusively to “Herx”.
It is dangerous from a public health point of view.
For example, a little more than ten years ago, allergic reactions to a local preparation for the respiratory system were prescribed in the form of “Herx”, only to later require skin treatment.
Conclusion
The Jarisch-Herxheimer reaction has been known in medicine for more than 120 years and occurs more often in some infectious diseases, for example, caused by spirochete bacteria. That term is real, but it should not be misused to cover up the side effects of preparations and procedures.
Nor is it good to impose the idea that every treatment process is always associated with deterioration. Healing is not a competition either, so keep it in your intimate circle.
